INDOHUN News No. 6

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The Sixth Edition, September 2015

Training the Future True Leaders


Global Health

To Prevent and Control

Travel advice on MERS-CoV for pilgrimages As of May 2014, more than 635 cases of Middle East respiratory syndrome coronavirus (MERS-CoV) have been reported to WHO. The virus appears to be circulating widely throughout the Arabian Peninsula and most MERS cases have been reported by the Kingdom of Saudi Arabia. While most cases have occurred among residents, some cases have occurred among visitors. Based on currently available information, the overall risk for visitors to acquire MERS infection appears to be low. A typical case of MERS includes of fever, cough, and/or shortness of breath. Gastrointestinal symptoms, including diarrhoea, have also been reported. The virus appears to cause more severe disease in people with weakened immune systems, older people, and those with such chronic diseases as diabetes, cancer and chronic lung disease.

It is important for countries to use all practical and effective means possible to communicate information on a range of issues before. During and after Umra and Hajj to all key groups, including the following:  travellers to Umra and Hajj, particularly vulnerable groups within this population;  public health officials;  health care staff responsible for the care of ill pilgrims;  transportation and tourism industries; and  the general public. 1

Source: WHO, SaudiMOH

Travel advice on MERS-CoV for pilgrimages Actions for countries to take in preparation for Umra and Hajj Countries should advise travellers that people with pre-existing major medical conditions (e.g. diabetes, chronic lung disease, chronic renal disease, immunodeficiency etc.) are more likely to develop severe infection for MERS if they are exposed to the virus. Pilgrims should be advised to consult a health care provider before travelling to review the risk and assess whether making the pilgrimage is advisable.

Countries should advise travellers and travel organizations on general travel health precautions, which will lower the risk of infection in general, including influenza and traveller’s diarrhoea. Specific emphasis should be placed on:  hand hygiene and respiratory hygiene (covering mouth and nose when coughing or sneezing, washing hands after contact with respiratory secretions, and keeping a distance of one metre with other persons when having acute febrile respiratory symptoms);  adhering to good food-safety practices, such as avoiding undercooked meat or food prepared under unsanitary conditions, and properly washing fruits and vegetables before eating them;  maintaining good personal hygiene. Source: WHO, SaudiMOH 2

Travel advice on MERS-CoV for pilgrimages Actions for countries to take in preparation for Umra and Hajj Countries should make health related advice available to all travellers departing for Umra or Hajj by working with the travel and tourism sectors and placing such materials at strategic locations (e.g. travel agent offices or points of departure in airports). Different kinds of communication, such as health alerts on board of planes and ships, and banners, pamphlets and radio announcements at international points of entry, can also be used to reach travellers. Travel advice should include current information on MERS-CoV and guidance on how to avoid illness while travelling. Countries should ensure that they have access to adequate laboratory services for testing for MERS-CoV and that information on how to obtain laboratory services and clinical referral is known to health care providers and facilities. Countries should advise travellers to delay their travel if they develop a significant acute respiratory illness with fever and cough. Countries should provide medical staff accompanying pilgrims with up to date information and guidance on MERS-CoV, ensuring that: • they are alert to the early signs of a developing respiratory infection and pneumonia: • they know who is considered to be in a high-risk group; • they know what to do when a suspected case is identified; • they are aware of simple health measures to reduce transmission. Source: WHO, SaudiMOH

Travel advice on MERS-CoV for pilgrimages Infection prevention and control measures are critical to prevent the possible spread of MERS-CoV in health care facilities. Health care facilities that provide care for patients suspected or confirmed to be infected with MERS-CoV infection should take appropriate measure to decrease the risk of transmission of the virus from an infected patient to other patients, health care workers, and visitors. Health care workers should be educated, trained, and refreshed with skills on infection prevention and control.

Actions to take during Umra or Hajj Countries should advise travellers that if they develop a significant acute respiratory illness with fever and cough (severe enough to interfere with usual daily activities) during Umra or Hajj, they should:  report to the medical staff accompanying the group or to the local health services;  cover their mouth and nose when coughing or sneezing, wash hands afterwards, or if this is not possible, cough or sneeze into upper sleeves of their clothing;  avoid attending crowded places and preferably isolate themselves until the end of the respiratory symptoms and, if isolation is not possible, use a tissue for covering nose and mouth or a surgical mask when in crowded places. Countries should advise travellers to avoid close contact with camels, visit farms and consume unpasteurized camel milk, urine or improperly cooked meat. Source: WHO, SaudiMOH


Travel advice on MERS-CoV for pilgrimages WHO advise travellers who develop a significant acute respiratory illness with fever and cough (severe enough to interfere with usual daily activities) to: minimize their contact with others to keep from infecting them; cover their mouth and nose with a tissue when coughing or sneezing, then discard the tissue in the trash after use and wash hands afterwards, or, if this is not possible, to cough or sneeze into the upper sleeves of their clothing, but not into their hands; and report to medical staff as soon as possible.

Actions to take after Umra or Hajj Countries should advise returning travellers that if they develop a significant acute respiratory illness with fever and cough (severe enough to interfere with usual daily activities) during the two weeks after their return, they should:  seek medical attention, informing health attendants of their recent travel for Umra or Hajj;  immediately notify their local health authority;  take precautions when coughing or sneezing;  minimize their contact with others to keep from infecting them. Countries should alert health practitioners and facilities to test returning travellers with a clinical presentation that suggests the diagnosis of MERS-CoV to be tested for MERS-CoV and to implement infection prevention and control measures. Confirmed cases of MERS-CoV must be reported to WHO. Clinicians should also be alerted to the possibility of atypical presentations in patients who are immunocompromised. 5

Source: WHO, SaudiMOH

Rabies W rld Day September 28 is World Rabies Day, a global health observance that seeks to raise awareness about rabies and enhance prevention and control efforts.

Dogs are also victims of rabies. Not only are they subject to the disease's horrific clinical symptoms, estimates suggest millions of dogs are killed in culls every year in misguided attempts to control the disease

Rabies is a viral disease that is transmitted through the saliva or tissues from the nervous system from an infected mammal to another mammal, usually through a bite. Needless deaths It is currently responsible for an estimated 59,000 human deaths a year, almost all transmitted via dog bites. Up to 60% of all rabies deaths are children under the age of 15. Very few victims have access to the palliative care that would alleviate the suffering of their final days. However, despite its almost 100% case fatality rate, canine rabies is completely preventable with modern vaccines. Nobody need die of rabies.

The rabies virus infects the central nervous system, ultimately causing disease in the brain and death. The early symptoms of rabies in people are similar to that of many other illnesses, including fever, headache, and general weakness or discomfort. As the disease progresses, more specific symptoms appear and may include insomnia, anxiety, confusion, slight or partial paralysis, excitation, hallucinations, agitation, hypersalivation (increase in saliva), difficulty swallowing, and hydrophobia (fear of water). Death usually occurs within days of the onset of these symptoms.

How is Rabies Transmitted? Transmission of rabies virus usually begins when infected saliva of a host is passed to an uninfected animal. The most common mode of rabies virus transmission is through the bite and virus-containing saliva of an infected host. Though transmission has been rarely documented via other routes such as contamination of mucous membranes (i.e., eyes, nose, mouth), aerosol transmission, and corneal and organ transplantations. Source: CDC, GARC 6

Rabies W rld Day What to do if you’re bitten?

What is the risk for my pet? Unvaccinated dogs, cats, and ferrets exposed to a rabid animal should be euthanized immediately. If the owner is unwilling to have this done, the animal should be placed in strict isolation for 6 months and vaccinated 1 month before being released. Animals with expired vaccinations need to be evaluated on a case-by-case basis. Dogs and cats that are currently vaccinated are kept under observation for 45 days.

1. Wash the wound. Wash the bite wound throughly with soap and water for 15 minutes. Apply ethanol or a similar antiseptic to prevent secondary infection. 2. Seek urgent medical attention. Postexposure prophylaxis (PEP) is the course of vaccines that prevent the onset of clinical symptoms of rabies in people. Modern vaccines are the only way to prevent the onset of rabies after exposure. Traditional remedies, such as jackfruit gum and chilli powder, will not protect you against the rabies virus. 3. Watch the animal. Where possible, watch the biting animal for signs of illness for 14 days. Do not kill the animal. If they animal dies, report the incident to the veterinary authorities.

How to Prevent Rabies? Dog vaccination is the most reliable, sustainable, and cost effective way to prevent rabies in people. Although dogs are the primary source of rabies, rabies can affect other animals too and it is wise to vaccinate all your animals against rabies, particularly livestock. Vaccinate your family's animals against rabies to protect them and help protect you and your family too. 7

Preventing and controlling rabies begins at the community level, where people can take the necessary steps to keep themselves, their family, and their pets free from rabies. Community health officials play an instrumental role in making sure people have the ability to take action and learn just how deadly rabies can be. Source: CDC, GARC

One Health Community-Empowerment In order to control zoonotic disease, INDOHUN need to collaborate with all stakeholders across sector, One of the most important part is community, particularly community that located in area with high rate of zoonotic disease. Empowering the community can be done by university students. In order to enhance student capacity in empowering community on One Health, this program need to be implemented under faculty and university program. Thus, INDOHUN conduct CommunityEmpowerment Workshop on One Health to facilitate faculties implementing this program.

This workshop was conducted in Surabaya, East Java, Indonesia on July 29, 2015, by bringing together deans from selected faculty member represent 3 disciplines of medicine, public health, and veterinary medicine.

The aims of this workshop were to develop manual of community- empowerment on One Health. Total participants are 14 persons from 14 faculties member. The participants were put into 3 groups consist of 5 persons with 3 different disciplines each group with manual template given. Each group was assigned to develop guidance, one group to develop community-empowerment program manual for medicine faculty, one group for public health, and one group for veterinary medicine faculty.

This workshop shows that One Health approach in conducting community empowerment program was very welcome and the participants were very delighted to develop the manual and eager to implement this program in their faculty.


Global Health True Leaders BATCH 5 Global Health True Leaders (GHTL) is a leadership training that aim to address the lack of leadership skill as well as collaboration across sector and profession within One Health Workforce in tackling zoonotic disease.

Global Health True Leaders Batch 5 involving 74 participants 17 universities around Indonesia GHTL Batch 5 was conducted with 5-days-in class training followed by 2-days field work and leadership initiative program in Pontianak, West Kalimantan, Indonesia on August 19-25, 2015. Involving number of 74 participants from students from 17 universities all over Indonesia and young professional represent 10 disciplines of Medicine, Veterinary Medicine, Public Health, Nutrition, Nursing, Pharmacy, Biochemistry, Molecular Biology, Dentistry, and Engineering.

GHTL Batch 5 invited five distinguished trainers from Tufts University, INDOHUN member faculties, and Coordinating Ministry of Human Development and Culture - National Commission for Zoonoses Control The trainers share their knowledge and experience for enhancing participant’s capacity, they are Prof. Wiku Adisasmito, DVM, M.Sc., Ph.D; Prof. Stanley Fenwick, BVMS, M.Sc., Ph.D; Prof. Adik Wibowo, MD, MPH, Dr.PH; Dr. Ni Nyoman Sri Budayanti, MD, Sp.MK(K).; and Rama Prima Syahti Fauzi, DVM, M.Si. 9

Global Health True Leaders BATCH 5 Leadership

Important Values

Participants were trained to be true leaders who have strategic skills including effective communication and dealing with the wide range of leadership action from high-level in intellectual setting by conducting simulation of national coordination meeting about outbreak that must give strong argumentation using English to the ground-level by serving district community as front liner health professionals through fieldwork.

During GHTL Batch 5, INDOHUN set the agenda strictly so that participant learned that discipline is the important element as true leaders. In collaboration with Regional Police Command of West Kalimantan, an outbound of leadership initiative program on August 25, 2015 was held as a field experience to build and strengthen participants’ team work, self-resilience, and problem solving skill through various challenges of military obstacles, such as mud run, raffling from 20 meters height, stairs obstacle, log wall, rope climb, and cargo nets.

Global Health True Leaders BATCH 5

Important Values

Global Perspective

Participants were exposed and taught to build global perspective inside their mind through materials and the role play. In one of GHTL role play, participant played a role as a stakeholder who tried to deliver a press release on given problem about outbreak which required them to give strong opinion and position in addressing journalist interrogatory.

Working Multi-sectoral and Across Professions

The Global Health True Leaders was designed to enhance interaction between participant through case study, role play, and group assignment that required solution from multi-sectoral perspective from across profession. During GHTL, participants were grouped in small group that consist of various profession and every participants had opportunity to be a group leader since the leader should change each day.


Global Health True Leaders BATCH 5 Culture

Important Values

Subsequent to in-class training, participants skill particularly on community engagement were built up since they had to perform health promotion for children, youth, local community, and cattleman in a remote area in West Kalimantan. The fieldwork had strengthened their unity within their diversity (Bhineka Tunggal Ika) to achieve their common goal.

GHTL also taught participant to respect the diversity of Indonesia cultures through group performance including traditional dance, poem, and theatricals in GHTL culture night.


Global Health True Leaders BATCH 5

GHTL Batch 5 has provided new true leaders with global perspective, uphold strong leadership value to collaborate across sector and profession, and apprise culture value within both community and health regulatory hierarchy.

The successful execution of GHTL this year, multi-sectoral contribution, and support from all parties involved will become strong inspiration to us in continuing and bringing this program to the new level in the upcoming year.

So that, the benefits of this ‘Global Health True Leaders’ program can be shared and expand to as many potentials health workforces as possible and to national, regional, and international level.

Global Health True Leaders BATCH 5 “Global Health True Leaders Batch 5 in Pontianak was a brand new experience for me, maybe most of us. The fact that the chosen participants were from various major/subjects made it even more meaningful, which led us to broaden our networking and the programs had just tightened our bonds.” Ratih Setiawati, Undergraduate Student-Faculty of Medicine, Airlangga University

“Global Health True Leader Batch 5 is one of the most amazing programs I've ever joined. It gives so many experiences and precious values, like leadership, friendship, love, patient, discipline, family! MILLION THUMBS UP!” Antony Halim, Undergraduate Student-Faculty of Medicine, Tanjungpura University

“Currently, Global Health issues include in the core unresolved. In the future, Indonesia needs a dedicated leader in the health and education support. This program can train young people become a leader and can be solving health problem in the world. This program facilitates the younger generations who are competent in their fields manage and became true leaders. IT’S GREAT TO BE US!” Nuke Annisa Nasution, Research Student-Eijkman Institute

“I was very thankful connecting to a great people around Indonesia to discuss health problems and share their experiences. I believe, GHTL alumni would create such a great networking and planning for better Indonesia. From GHTL to a shining future....” Yuni Dwi Setiyawati, Dietitian-Primary Health Care of Penimbung, West Nusa Tenggara

“Global Health True Leaders program is a must program to be participated by all health young practitioners or students. It did not only enhance your capabilities in One Health issues but also strengthen your networks among the global health young professional. Three words for GHTL are acknowledging, inspiring, and fun.” Annisa Ika Putri, Research Assistant-Center of Epidemiological Research & Surveillance


Global Health True Leaders ?


Indonesia One Health University Network (INDOHUN) Faculty of Public Health University of Indonesia, G Building, 3rd Floor, Room G316 Depok – West Java (16424) Phone & Fax : 6221 2930 2084 E-mail : Website :